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RC: Hello everyone, this is Liz Harvey coming to you from our studio in New York City where we are dedicated to bringing you cutting edge interviews from many of the leading industry professionals across the United States.

In today’s episode, we are speaking with Stephanie Heintzeler. Stephanie is a German educated midwife, a U.S. educated doula, an acupuncturist and she is a certified lactation counselor (CLC). She is known as The New York Doula.

Stephanie has delivered over 1200 babies and has experience with twins, triplets, breech babies and water births. She also works with newborn parents in their postpartum stage and holds classes and seminars for moms and dads to be.

With a wealth of experience and knowledge in her field, Stephanie Heintzeler is widely considered to be one of the top doulas in the country. She is also a contributing member of our national network of industry professionals.

Today we are going to talk about a very important topic: Births After C-Section

RC: Hello Stephanie, how are you today?

Stephanie Heintzeler: I’m very well. Thank you.

RC: Thank you so much for being here.

Question 1: The acronym VBAC stands for Vaginal Birth after C-Section. Are there risks for a woman choosing a vaginal birth after having a C-Section?

RC: If I can jump right in. The acronym VBAC stands for vaginal birth after C-section. Are there risks for a woman choosing a vaginal birth after having a C-section?

Stephanie Heintzeler: Yes. There are risks. It kind of depends on why the first C-section happened. Sometimes risks are lower, sometimes risks are higher. The main risk is a so called uterine rupture but American College of Obstetricians and Gynecologists which is the big organization in the United States, they named this uterine rupture in a vaginal delivery after a C-section as .2 to 1.5%, so the chance is about 1 over 5000 which is very very low. Generally the American association they still recommend to try a VBAC and go for a VBAC if you had a C-section the first time.

Question 2: What leads to a successful vaginal birth after a C-Section?

RC: What leads to a successful vaginal birth after a C-section?

Stephanie Heintzeler: It really depends on the mother, what the mother wants because one thing is recommendation and what’s better for the child and it’s mostly better for the mother which would be vaginal birth but if a mother doesn’t want a vaginal birth then clearly no one should get pushed to do something that she doesn’t want to do. Most moms want a vaginal birth after a C-section because they didn’t want a C-section in the first place. The most important thing is that you find a good obstetrician or a midwife who supports VBAC’s.

Because some doctors say, “Yeah, we’re going to do that” but then they never really have done it or they are just look for the very first issue that is happening in labor and they’re like, “Okay, now we can’t do it anymore.” That is the main thing and the other thing is that a few things are important in terms of the pregnancy. This original reason for the cesarean delivery the first time should not be repeated with this pregnancy now. The baby should be head down. The baby should be in a normal size. It shouldn’t be multiple, like no twins. The mother should not have diabetes. No high blood pressure. If you have a normal pregnancy there is no reason to not have a vaginal birth.

Question 3: When would you recommend that someone NOT try a VBAC?

RC: When would you recommend that someone not try a VBAC?

Stephanie Heintzeler: If the original reason for the first delivery is repeated. Let’s say, I’m having twins again or I’m having a breech baby again or I’m having really high blood pressure and it is dangerous to plan for a vaginal birth – things like that but there are a few other reasons. For example, the mother should not have any additional uterine scars like she should not have had any other surgeries besides that one C-section. She should deliver in a bigger hospital; if she is leaving the country and she is planning on a home birth that would not be ideal.

I’d rather her go to a hospital where just in case a C-section is necessary, you can have it. The other things – really don’t try VBAC if you’re not getting support, if you don’t have a doula, if your partner is not on the same page with you, if you’re OB, your doctor or midwife they’re not on the same page with you then you’d rather get disappointed so in that case discuss that beforehand and then make your decision.

Question 4: Does having more than one C-Section pose additional risks for future pregnancies?

RC: Great. Does having more than one C-section pose additional risks for future pregnancies?

Stephanie Heintzeler: Yeah. Let’s say if you had 2 C-sections, the risks are getting higher for example for lower back issues. From physical therapists, I often hear that mothers who have had 1 or 2 C-sections or even more C-sections they often have disc herniations because during the C-section everything gets cut in the front in the belly and the muscles and the uterus so then you have your newborn and you keep carrying a newborn at the same time you’re abs are not really doing anything so all the pressure goes on your back. And of course, the more kids you have and the less strength you have because of all these C-sections, the more risk is that your lower back goes out.

The other risks are longer recovery in general. There is a low number of risks during the third pregnancy if you have 2 C-sections because the placenta might attach to the scar tissue because the scar tissue is bigger and thicker and if your placenta attaches to that scar tissue the third time, it can cause bleeding during the pregnancy or during another C-section. The more C-sections, the riskier the following pregnancies are.

Question 5: How do you plan for a VBAC? Do contingency plans need to also be in place for a C-Section?

RC: How do you plan for a VBAC? Do contingency plans need to also be in place for a C-section?

Stephanie Heintzeler: Yeah. You know, with VBAC … I have a lot of VBAC mothers and so far so good, knock on wood. We’ve always had a successful VBAC. Sometimes babies decide to be in a funky position so then early on it’s decided to do a C-section. Mothers really need to plan for both kinds of births because chances are maybe during that labor, she might end up in a C-section but if there’s no reason, if the obstetrician or midwife is very supportive, usually another C-section is not necessary. Plan for VBAC by really aiming for the vaginal birth, making a birth plan for your vaginal birth, hire a doula because with a doula you lower your C-section rate by 40% because you really are aware of all kinds of risks and also you have a better chance of having the birth that you want in terms of maybe less medication, good positioning and staying at home a long time so you’re relaxed.

If you’re relaxed, you generally have less pain and you need less intervention and if you have less intervention, the chances are you’re going to have the vaginal birth because with interventions we kick up the rate for C-section. At the same time, it’s important to look at the fact that of course it might end up in a C-section so we would look at why did the first C-section happen and how was that for the mother emotionally? See what helped her and what didn’t help and really make a plan so that if suddenly a C-section is necessary whether it is suddenly planned or during labor that we really know what made her feel comfortable the last time.

Some moms got nauseous the first time. Some moms really panic because they couldn’t breathe so well during the C-section or they were really really achy after birth or they didn’t have support in place after birth because of course with a C-section, you can’t really take care of your children and now of course you have children because you’re having the VBAC or planned VBAC with another child. That way you really want to make sure that you have everything in place for both kinds of births. Most of the time the VBAC is successful because every doctor and midwife rules out anyone who might be at a higher risk but it’s important to plan both ways.

RC: Well thank you so much Stephanie. We know you’re extremely busy so I just want to thank you for all of your time and help today.

Stephanie Heintzeler: You’re very welcome. Thanks for having me.

RC: For our listeners across the country if you are interested in speaking with Stephanie Heintzeler you can either go online to https://www.thenewyorkdoula.com or call (917) 399-2031 to schedule an appointment. On behalf of our entire team we want to thank you for listening and we look forward to bringing you more top quality content from our country’s leading industry professional’s.